The rates of obesity and diabetes have increased rapidly over the last 20 years, both in the United States and globally. The incidence of gestational diabetes mellitus (GDM) is also increasing, paralleling the overall rise in obesity and type-2 diabetes. The adoption of new diagnostic criteria based upon the recent Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study is expected to increase the prevalence of GDM to about 18% of all pregnancies. In light of the fact that 80-90% of women with GDM can be managed with lifestyle therapy alone, universal screening for GDM is increasingly considered justified.
GDM is a serious complication of pregnancy that can increase the risk of a number of maternal-fetal disorders, including macrosomia, shoulder dystocia or birth injury, premature delivery, and preeclampsia. In addition to the increased risk of complications associated with gestation and delivery, there are also serious post-natal complications associated with GDM. For instance, 5 to 10% of women with GDM are found to have diabetes immediately after pregnancy, and women who have had GDM have a 10-fold higher chance of developing diabetes within the next 10-20 years. Children of mothers with GDM have an eight-fold greater risk of developing type-2 diabetes in later life. Thus, untreated GDM contributes to the overall diabetic population in both the short and long term.
Universal or even widespread GDM screening is hampered by the fact that the standard assessments of diabetes and pre-diabetes, such as fasting insulin/glucose and HbA1c, are not recommended for screening of GDM. Instead, the recommended parameter is an oral glucose tolerance test (OGTT), which is costly and invasive, requiring a hospital visit and multiple blood draws.